Management of Patients with Failure Following Definitive Radiation Therapy: Reirradiation in Patients with Locally Recurrent Nasopharyngeal Carcinoma

Although excellent control rates can be achieved after primary treatment for NPC, local relapse still represents a major cause of treatment failure, particularly in patients presented with advanced primary disease. In managing local failures of NPC, aggressive salvage treatment with curative intent should always be considered, since a significant proportion of these patients can still achieve long-term survival after successful retreatment. In a retrospective review of a large cohort of 275 patients with local failure of NPC, patients who received salvage treatment had a sig-nificantly better survival compared with those without receiving any salvage treatment (Yu et al. 2005). Although patients with less extensive recurrence and better performance were likely to be selected for salvage treatment, this large series still showed that only patients who underwent surgery or reirradiation had a chance of achieving long-term disease control and survival. Many salvage treatments are available, and the choice of method depends on several factors including extent of disease, site of disease, any synchronous nodal relapse, cumulative radiation dose already received by patient, patient's general condition and preference, and expertise available. In general, salvage treatments with curative intent can be classified into surgery and reirradiation. This chapter covers different approaches of reirradiation in salvaging local failures of NPC, which include brachytherapy using intracavitary intubation, mould application or gold grain implantation, stereotactic radiotherapy, and external beam radiation therapy.